Remote Medical Director: Medicare & Medicaid Compliance

Humana; Topeka (KS); Remote; USD 224,000 - 313,000; Full time

Job summary

Humana, Inc. is seeking a Medical Director for OneHome to lead reviews of medical necessity for Medicare/Medicaid services and ensure compliance with CMS requirements and Humana policies. The role supports a remote, home-based work arrangement with training in EST and potential travel.

The candidate will interpret clinical guidelines, participate in educational activities, and contribute to a collaborative team focused on delivering high-quality consumer experiences within regulatory standards.

Qualifications

• MD or DO degree is required.
• Current, active board certification from ABMS or AOABPS is required; NB PAS certification is not accepted.
• Current and unrestricted state medical license in at least one state and willingness to obtain licenses as required.

Responsibilities

• Review clinical cases and determine medical necessity for Medicare/Medicaid members.
• Ensure compliance with review policies, procedures, and regulatory standards.
• Apply CMS policies, Medicare requirements and clinical guidelines.
• Identify opportunities for medical management operational improvements.
• Participate in call rotations including weekends and after-hours.

Skills

Strong verbal and writtencommunication

Microsoft Office proficiency

Adaptable to new technologies

Education

MD or DO degree

Tools

Microsoft Office

Job description

Humana, Inc. is seeking a Medical Director for OneHome to lead reviews of medical necessity for Medicare/Medicaid services and ensure compliance with CMS requirements and Humana policies. The role supports a remote, home-based work arrangement with training in EST and potential travel.

The candidate will interpret clinical guidelines, participate in educational activities, and contribute to a collaborative team focused on delivering high-quality consumer experiences within regulatory standards.